This application will take you several minutes to complete. You'll be asked for your general contact information, any special circumstances or considerations.
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Information About You
Email is the Foundation's primary communication method. Please provide your main email address. If you are the adult filling out this form for a minor, please use your email address here.
If you have another email address which you check regularly (daily) enter it here.
(If you are the adult filling out this form for a minor or someone without a phone, please use your phone number here.)
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Select Your Spa Services and Activities
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Select one or all. We will fit in as much as possible in your already busy Saturday schedule!
More About You
Please list all allergies, medications, and or other medical conditions we should be made aware of in order to best support you at Camp.
Mission Springs is not ADA compliant (yet) and even first floor rooms have a single step at the entrance. Upper floor rooms are accessed via stairs. Many sleeping rooms are furnished with a combination of standard beds and bunk beds. We will try our best to accommodate you but cannot guarantee easy access for all. Also, please note that your room will not have air conditioning. Fans can be provided if needed.
We will do all we can to meet your needs. However, in some cases, you may be asked to bring your own special food if we are unable to provide.
Anything else you care to share?
Agreements
With the continuing presence of COVID-19 in the US, the safety and well-being of our families and volunteers is always our top priority. Mitigation strategies and protocols are subject to change up to the time of and during Camp Wieser 2024.
All camper families, volunteers and vendors will complete a self-administered COVID-19 test the day prior to arrival at Camp Wieser. It is recommended that EVERYONE (6 months and older) arrives having tested negative for COVID-19. The Foundation knows each of our participants will do their best to be as healthy as possible and not come to camp with any fever or symptoms of illness.
Revision: 5/21/24 5:30 pm
RELEASE, WAIVER OF LIABILITY, MEDICAL AUTHORIZATION & PHOTO RELEASE
The applicant on behalf of him/herself, their agents, heirs and representatives hereby releases, waives, discharges and covenants not to sue Camp Wieser, Me‐One Foundation or any of its affiliates, members of its Board of Directors, employees, agents, contractors, volunteers and all other camp personnel whether volunteers or paid staff, (hereinafter referred to as “Releasee(s))” for any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorney’s fees and expenses) to the undersigned and/or to any minor child being signed for, on account of physical, mental, or emotional injury, an outbreak of any and all communicable disease, including but not limited to, the virus “severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)”, which is responsible for Coronavirus Disease (COVID-19) and/or any mutation or variation thereof, or death of the person or minor child or to the property of the person or minor child, whether such injury or death be caused by the negligence, gross negligence of the Releasee(s) or otherwise, while the person or minor child participates in Camp. Notwithstanding any other provision of this Release and Waiver, the undersigned also releases Me-One Foundation, but no other Releasee from any liability whatsoever arising from any injury, damage, or death to the person or minor child where said injury, damage, or death is the result of, or arises from any intentional or criminal conduct upon the part of a Me-One employee, agent, volunteer, camp counselor, or any other camp personnel.
The applicant grants permission for the Me‐One Foundation affiliated medical volunteers to treat and act upon any and all medical conditions as deemed appropriate by them.
The undersigned hereby releases, waives, discharges and covenants not to sue Camp nor the Me‐One Foundation or any of its affiliates, members of its Board of Directors, employees, agents, contractors, volunteers and all other camp personnel whether volunteers or paid staff for any and all liability, claims, demands, damages, causes of action, losses, or expenses (including attorney’s fees and expenses) to the undersigned and/or to any minor child being signed for.
The applicant hereby grants Camp Wieser and/or the Me‐One Foundation or any of its affiliates, members of its Board of Directors, employees, agents, contractors, volunteers, guests and all other camp personnel, whether volunteers or paid staff, permission to allow, take, release or utilize pictures and/or recordings of an audio or visual nature or both of themselves and/or any minor they are signing for, as deemed appropriate by Camp Wieser and/or the Me‐One Foundation for means of public relations, marketing, media or otherwise.
The applicant further expressly agrees that the foregoing release and waiver is intended to be as broad and inclusive as is permitted by the law of the State of California, and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effort.
The applicant has read and voluntarily signs the Release and Waiver of Liability and Photo Release and further agrees that no oral representations, statement or inducement apart from the foregoing have been made, and that this Agreement may only be modified by a written document signed by the applicant and a duly authorized representative of the Me‐One Foundation.
Revised 11 May 2023
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You're coming to Camp! Thank you for wanting to support your special Camper. It will mean so much to them, and I will let them know you are joining their camp family.
Cathy Perry
Camper Ambassador
cathy@nullme-onefoundation.org
